Optical Coherence Tomography Evaluation of Superficial Femoral Artery Directional Atherectomy

J INVASIVE CARDIOL 2019;31(5):E93-E94.

Key words: directional atherectomy, optical coherence tomography, superficial femoral artery

A 70-year-old man presented with lifestyle-limiting intermittent claudication (Rutherford stage III) affecting the right lower extremity. Physical examination of the right lower limb revealed weak distal pulses and a diminished ankle-brachial index of 0.6. Peripheral angiogram showed diffuse 80% stenosis over the right distal superficial femoral artery (SFA).

The HawkOne directional atherectomy system (Medtronic Peripheral) was used to restore blood flow by removing plaque. After placing a 7 mm SpiderFX device (Medtronic Peripheral), optical coherence tomography (OCT) was acquired to assess baseline plaque load (Figure 1). Several runs of directional atherectomy were done. Angiogram and OCT were then obtained to assess the result of directional atherectomy (Figure 2). Drug-eluting balloon was applied afterward. The final angiographic result was excellent. A 3-month course of dual-antiplatelet therapy was given, followed by lifelong aspirin. There was no recurrence of symptoms at subsequent 1-year follow-up.

Vessel dissection following atherectomy or balloon angioplasty is the most common reason for bail-out stenting in the SFA. Yet, the use of stents has several potential shortcomings, including stent fracture. OCT can accurately assess the effect of endovascular interventions to the vessel wall, providing excellent resolution for any presence of microdissections, residual clot, and suboptimal minimum lumen area. A trial has shown OCT-guided atherectomy for femoropopliteal disease to be safe and effective, yet data in the Asia-Pacific population are limited. To the best of our knowledge, this is the first report of OCT evaluation of SFA atherectomy in the Asia-Pacific region. We demonstrate the possible feasibility of this technique in Chinese populations.

From the Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted November 15, 2018.

Address for correspondence: Dr Wai Kin Chi, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR, China. Email: chiwaikin@gmail.com